Cause Of Maternal Death Research Articles

A review of the use of CT pulmonary angiography in pregnant and postpartum women at an academic centre

Background Pulmonary embolism (PE) is a common cause of maternal death during pregnancy and the puerperium yet data on its prevalence in middle-income countries is lacking. Methods We examined the medical records and CTPA (computed tomography pulmonary angiography) images of 67 women in an obstetric high care unit during pregnancy and the puerperium. We aimed to determine the prevalence of PE in a high-risk obstetric population undergoing CTPA, assess associated clinical features in this cohort, and determine the prevalence of alternative CT findings. Results CTPA detected PE in 11 women (16.42%) and alternative CT findings in 46 (68.6%). Women with PE had a lower systolic blood pressure than those without PE ( P = 0.001). Multiple gestation, preterm rupture of membranes, and gestational diabetes were linked to higher PE prevalence. Conclusions This study, set in an upper middle-income country, demonstrated a higher CTPA yield for PE and alternative diagnoses than in international literature, emphasising context-specific assessments.

Pengaruh Pemberian Jus Buah Naga terhadap Perubahan Kadar Hemoglobin Ibu Hamil di Wilayah Kerja Puskesmas Kota Baru Kabupaten Indragiri Hilir

The prevalence of iron deficiency anemia in pregnancy is around 95% due to iron deficiency (iron deficiency anemia). Anemia is the second main cause of maternal death, accounting for around 12.8% of maternal deaths due to postpartum hemorrhage. One way to overcome anemia in pregnancy is to consume dragon fruit regularly, in addition to consuming Fe tablets that have been given by midwives or health workers. Giving dragon fruit juice is effective in increasing Hb levels in pregnant women. The research design used in this study was a pre-test and post-test with control group design in the Kota Baru Health Center Working Area, Indragiri Hilir Regency. A population of 230 pregnant women with a sampling technique using simple random sampling obtained 32 respondents (16 intervention groups and 16 control groups). Data analysis used the independent t-test. The results of this study indicate that there is an effect of giving dragon fruit juice on changes in hemoglobin levels of pregnant women in the Kota Baru Health Center Working Area, Indragiri Hilir Regency. Dragon fruit can be used as a supplement to increase hemoglobin levels in pregnant women to treat anemia.

Maternal Mortality in the Governorate of Tunis between 2017 and 2023: evolution of Maternal Mortality Ratio and the main causes of death

Background Maternal mortality is the main indicator of maternal health worldwide. The aims of your study were to determine the Maternal Mortality Ratio (MMR) in the governorate of Tunis and to identify the main causes of maternal death. Methods We included all maternal deaths between January 2017 and December 2023, reported to the Tunis Regional Health Directorate. The data collected included the MMR per 100000 live birth, sociodemographic characteristics, causes of death, circumstances of death, autopsy findings, and preventability. Results Sixty one maternal deaths were recorded. The average of MMR was 46, 88 per 100000 live births. Two peaks in the MMR were noted in 2017 and 2020. The average age of the patients was 34, 1 years (±5.1). We noted that 43, 75 % of the patients were not residents of the governorate of Tunis. The postpartum period was the most critical. In fact, 83, 33 % of maternal deaths occurred postpartum. Hemorrhage was the main etiology in 20.8% of cases. The second cause was COVID- 19complicationsin 16, 6% of cases. Conclusion This study of maternal mortality in Tunis opens the debate on the effectiveness of maternal health policies in Tunisia and the areas for improvement.

Women's satisfaction with comprehensive abortion care services and associated factors in central Gondar zone public primary hospitals, northwest Ethiopia, 2023.

Abortion complications are the leading causes of maternal death in low and middle-income countries, including Ethiopia. Providing quality and comprehensive abortion care services is crucial for improving the health of women and increased their satisfaction. Evaluating a client's satisfaction with abortion care is clinically relevant since women's satisfaction with health services is one of the key indicators of high-quality healthcare services. Therefore, this study aimed to assess women's satisfaction with comprehensive abortion care services and associated factors. An institution-based cross-sectional study was implemented among 333 women in Central Gondar Zone public primary hospitals from October 1, 2022, to April 30, 2023. Eligible participants were selected using a systematic random sampling technique. The data was collected using an interviewer-administered semi-structured, and pretested questionnaire. STATA version 17 and SPSS version 25 software were used for data entry and analysis respectively. Bivariable and multivariable logistic regression models were used to identify factors associated with clients' satisfaction with comprehensive abortion care services. A P-value of ≤0.05 with a 95% confidence interval was the cutoff point for determining statistical significance. This study revealed that the level of client satisfaction with comprehensive abortion care services was 60.4% (95% CI: 55.0%, 66.0%). The use of abortion medication (AOR = 4.41, 95% CI: 2.59, 7.48), women's age 20-24 years (AOR = 2.94, 95% CI: 1.02, 8.48), and being a student (AOR = 2.88, 95% CI: 1.10, 7.51) were significantly associated with women's satisfaction with comprehensive abortion care services. Women's satisfaction with comprehensive abortion care services was relatively low, and it was strongly correlated with the method of abortion, age, and occupation. To improve women's satisfaction requires a comprehensive understanding of women's values and perspectives, providing sexual and reproductive health education, and quality abortion care services are recommended.

The impact of birth preparedness and complication readiness (BPCR) on maternal outcomes among postpartum mothers

<pre><strong><em>Background: </em></strong><em>Birth preparedness and complications readiness (BPCR) is a strategy to prevent three late causes of maternal death. Previous study results focused on BPCR intermediate outcomes, such as utilizing healthcare facilities during pregnancy and delivery,</em><em> rather than maternal outcomes like maternal near miss, morbidity, and mortality.</em><em></em></pre><pre><strong><em>Objectives:</em></strong><em> This study examined the correlation between BPCR practices and maternal outcomes among postpartum mothers</em><em></em></pre><pre><strong><em>Methods: </em></strong><em>This cross-sectional research was conducted on postpartum mothers in the working area of the Sumberbaru Primary Health Service, Jember Regency, which was carried out from April to June 2023. A total of 78 postpartum mothers were selected using simple random sampling. The interview instrument was adopted from the BPCR JHPIEGO questionnaire, and maternal outcome observations were made using the MCH book. Data were analyzed using the chi-square test to examine the relationship between BPCR and maternal outcome. The level of statistical significance was set to p-value < 0.05</em><em></em></pre><p><strong><em>Results: </em></strong><em>The results of this study indicated that 69.2% of postpartum mothers had less prepared BPCR practices, and for most postpartum women, 55.1% recovered. There was a relationship between BPCR practices and maternal outcomes among postpartum mothers (p-value<0.05). Postpartum mothers with well-prepared BPCR practices had a 3.48 times higher chance of experiencing a complete recovery in maternal outcomes than those with less prepared BPCR practices.</em></p><pre><strong><em>Conclusions: </em></strong><em>The practice of BPCR in postpartum mothers is in the poor category; most mothers' maternal outcomes are in the fully recovered category. BPCR is an essential factor influencing maternal outcomes, so increasing counseling for mothers and families regarding BPCR is necessary to ensure more optimal maternal outcomes.</em><em></em></pre><p><em> </em></p>

PELAKSANAAN ANTENATAL CARE DENGAN 10 T DIPUSKESMAS MUNGKUR AGUNG KECAMATAN KELUA

Maternal and child health is a priority for health development in Indonesia. The implementation of Ante Natal Care with 10 T in pregnant women affects the results of early detection of risks and complications during pregnancy. This cause of maternal death shows that maternal death can be prevented if the coverage of services is accompanied by good quality service. The purpose of the study was to determine the Implementation of Antenatal Care with 10 T at the Mungkur Agung Health Center, Kelua District. This research method with quantitative descriptive, with a population of all pregnant women at 20 weeks gestational age and over trimester II, III with a total sampling technique, namely pregnant women totaling 38 people Results: It was found that the implementation of ANC with 10 T according to the standard was (97.37%), %) and there was 1 (2.63%) pregnant women who in the implementation of ANC did not meet the 10 T standard.

Religious-Based Peer Education in Preeclampsia Prevention: Social Cognitive Theory and Information, Motivation, Behavioral Skill Model Approach to Improve Preeclampsia Preventive Behavior in Indonesia

Background:Preeclampsia is the second leading cause of maternal death, largely due to the failure to identify the condition early. Prevention behaviors for preeclampsia in pregnant women can be developed through the Social Cognitive Theory (SCT) and the Information-Motivation-Behavioral Skills (IMB) Model. Utilizing religious organizations with unique values and cultures to foster high levels of compliance, a Religious-Based Peer Education approach can optimize these preventive efforts. Objective:This research aims to analyze the influence of knowledge, skills, motivation, observational learning, husband's support, and self-efficacy on the formation of preeclampsia prevention behaviors. Methods:A non-equivalent pre- and post-test design was conducted in Bojonegoro district from August 2022 to February 2023. The sample consisted of 179 pregnant women in the intervention group and 168 in the control group. The intervention involved Religious-Based Peer Education, with peers being members of the Muslimat NU religious organization, while the control group received routine assistance from existing health cadres. Data were analyzed using path analysis. Results:The mean scores for knowledge, skills, and behavior in the intervention group were significantly higher than those in the control group (13.81 vs. 12.34; 2.37 vs. 1.95; 30.33 vs. 28.19; p < 0.001). The strongest factors influencing the formation of preeclampsia prevention behavior were screening skills (b = 0.74, p = 0.010; 95% CI: 0.03–0.23) and self-efficacy (b = 0.36, p = 0.010; 95% CI: 0.23–0.48). Conclusion:The SCT and IMB models, when applied through Religious-Based Peer Education, have proven effective in improving preeclampsia prevention behaviors. Ongoing training for peers and consistent support for pregnant women are essential to identify high-risk pregnancies and prevent maternal complications. Keywords: social cognitive theory; information-motivation-behavioral skills model; preeclampsia; religious-based peer education; behavior

EFEKTIVITAS PRENATAL YOGA DALAM MENGURANGI ANGKA KEJADIAN PRE EKLAMPSIA DI PMB TATI KUSMIRAN,S.Tr.KEB.,BD BEKASI TAHUN 2023

The three main causes of maternal death include bleeding (30%), hypertension in pregnancy or preeclampsia (25%), and infection (12%). Preeclampsia or eclampsia is the second most common cause of maternal death after bleeding. Exercise during pregnancy can increase stamina, make you sleep better, improve your mood, and reduce anxiety. Of this writing is to determine the effectiveness of prenatal yoga in reducing the incidence of pre-eclampsia in PMB Tati Kusmiran, S.Tr.Keb., BD Bekasi in 2023. This research design uses a true-experimental research design which is a Posttest-only control design, namely an experimental design using a sample to measure the frequency of the effectiveness of prenatal yoga in reducing the incidence of pre-eclampsia in PMB Tati Kusmiran, S.Tr.Keb., BD Bekasi, Identifying the effectiveness of prenatal yoga on the incidence of pre-eclampsia in pregnant women by carrying out interventions. There were differences between groups experiencing pre-eclampsia in the BP category <140/90 with a frequency of 69.2% and those who did not comply with the SOP had a frequency of 30.8%. 35.3% of those who experienced pre-eclampsia in the BP>160/110 category did prenatal yoga according to the SOP and 64.7% of those who did not according to the SOP. There is a difference in the mean scores for the two groups with a score difference of 0.47. Based on the results of the paired test, the value p = obtained p = 0.000 < 0.01, so H0 is rejected, meaning that statistically it shows that there is a difference in pre-eclampsia in pregnant women who do yoga according to the SOP and those who do yoga not according to the SOP. Based on the results of the paired test, the p= value was obtained, the p=0.000 <0.01 was obtained, so H0 was rejected, meaning that statistically it shows that there is a difference in pre-eclampsia in pregnant women who do yoga according to the SOP and those who do yoga not according to the SOP. The results of the normality test using the Shapiro Wilk test obtained a sig value. 0.000, which means that if the α value <0.05, it means Ho is rejected and it can be concluded that there is the effectiveness of prenatal yoga in reducing the incidence of pre-eclampsia in PMB Tati Kusmiran, S.Tr.Keb., BD Bekasi

Ethnic, geographical and altitude considerations and maternal mortality associated with HELLP syndrome in Ecuador: a population-based cohort study

BackgroundEclampsia and pre-eclampsia rank as the third leading causes of maternal death in Ecuador, following pre-existing chronic diseases and postpartum haemorrhage, as reported by the Ecuadorian National Institute of Statistics and Census (INEC). In contrast, HELLP (Haemolysis, Elevated Liver enzymes, Low Platelet count) syndrome remains underexplored epidemiologically, not only in Latin America but globally. This study marks the first population-based investigation into HELLP syndrome incidence and mortality in Ecuador, examining geographical variations, altitude influences and ethnic backgrounds.MethodsConducted as a retrospective population-based cohort study from 2015 to 2017, this research delves into the incidence, risk factors and maternal mortality associated with HELLP syndrome in Ecuador. Utilising data from INEC and the Ecuadorian Ministry of Health, we identified HELLP syndrome cases through ICD-10 (International Classification of Diseases, tenth revision) coding in hospitalised individuals. Logistic regression analysis was employed to explore association, whilst geospatial statistical analysis focused on cantons to identify significant spatial clusters. Primary outcome measures include HELLP syndrome incidence and maternal mortality, supplying crucial insights into the syndrome’s impact on maternal health in Ecuador.ResultsThe incidence of HELLP syndrome is 0.76 (0.69–0.84)/ 1000 deliveries. Afro-Ecuadorian communities have a higher risk (Odds Ratio (OR) = 2.18 (1.03–4.63)) compared to Indigenous Ecuadorian communities. Living at mid-level or high altitude is a significant risk factor OR of 2.79 (2.19–3.55) and an OR 3.61 (2.58–5.03), respectively. Being an older mother was also identified as a risk factor. Women living more than 20 km from the obstetric unit have an OR of 2.55 (2.05–3.18). Moreover, we found that cantons with higher crude HELLP syndrome incidence also have lower numbers of physicians (R = 0.503, p-value < 0.001). The mortality incidence of women with HELLP syndrome is 21.22 (12.05–20.59)/1000 deliveries with HELLP syndrome diagnoses.ConclusionsHigh altitude, advanced maternal age and geographical distance between residence and health centres are risk factors for HELLP syndrome. Maternal mortality in women with HELLP syndrome is higher than pre-eclampsia and eclampsia but comparable with previous reports in other countries.

Patient and community centered approaches to sepsis among birthing people

Sepsis is the second leading cause of maternal death in the U.S. For racial and ethnic minoritized birthing people, especially those who are Black and living in underserved communities, labor and postpartum are particularly vulnerable risk periods. To reduce sepsis-related morbidity and mortality and promote maternal health equity, community co-led, and co-designed interventions are urgently needed. In this commentary, we introduce the design and goals of our EnCoRe MoMS study as an exemplar for employing community based participatory research principals iteratively throughout the research process and integrated across all study aims. We also highlight our early lessons learned and recommendations for best practices. Our novel model and ongoing work have implications for scaling academic-community research partnerships for other causes of severe maternal morbidity and maternal health equity nationally.

Analysing space-time patterns of maternal mortality attributed to anaemia in Karnataka, India: a spatial epidemiological study

BackgroundMaternal health is a globally important health challenge and is the key indicator of healthcare services in any given region. One of the main objectives of Sustainable Development Goal 3.1...

Analysis of factors related to the incident of hypertension in pregnancy

Introduction: Pregnancy-related hypertension is defined as hypertension that develops during pregnancy, usually in the final month of the pregnancy or after 20 weeks of gestational age that was previously normal. Five to fifteen percent of pregnancy-related problems are caused by hypertension, which is also one of the leading causes of maternal death and morbidity. Objective: The purpose of this study is to determine how the risk of hypertension during pregnancy is related to maternal age, parity, pregnancy spacing, BMI, junk food consumption habits, and prenatal visits. Method: Case control research design was employed. Eighty control samples were acquired using a simple random technique, while forty samples from the case group were taken using the accidental technique. A questionnaire was used to collect data. The logistic regression test and the chi square test were used in the data analysis. This study was taken in Ardita's Clinic, Indonesia. This study's sample was taken using the total sampling technique involving 33 respondents. Result: The incidence of hypertension proved to be significantly correlated (p&lt;0.05) with maternal age, junk food consumption, and prenatal visits while parity, pregnancy interval, and BMI weren't associated with a significant correlation (p&gt;0.05). The most significant factor is the junk food consumption habit (OR=13.483). Conclusion: Women should plan their pregnancies at a peak age, avoid from junk food, and arrange many antenatal appointments in order to ensure a successful pregnancy.

Estimating causes of maternal death in data-sparse contexts.

Understanding the underlying causes of maternal death across all regions of the world is essential to inform policies and resource allocation to reduce the mortality burden. However, in many countries there exists very little data on the causes of maternal death, and data that do exist do not capture the entire population at risk. In this article, we present a Bayesian hierarchical multinomial model to estimate maternal cause of death distributions globally, regionally, and for all countries worldwide. The framework combines data from various sources to inform estimates, including data from civil registration and vital systems, smaller-scale surveys and studies, and high-quality data from confidential enquiries and surveillance systems. The framework accounts for varying data quality and coverage, and allows for situations where one or more causes of death are missing. We illustrate the results of the model on three case-study countries that have different data availability situations.

Perinatal women’s views and experiences of discussing suicide in maternity care settings: A qualitative study

BackgroundSuicide is a leading global cause of maternal death in the first year after birth. Limited research has explored which factors may support or prevent women from disclosing suicidality. This is important for informing appropriate approaches to identifying perinatal women who may require support. Aims(i) explore perinatal women’s views and experiences regarding the barriers, facilitators, and implications of identifying and disclosing suicidality in maternity care settings; and (ii) explore their perspectives on appropriate approaches for healthcare practitioners (HCPs) to take when asking about suicide during pregnancy or after birth. MethodsTwenty-one semi-structured interviews with perinatal women in the UK. Of these women, 17 had experienced self-reported perinatal mental health (PMH) problems and/or suicidality. Inductive thematic analysis was used to explore the data and identify themes. ResultsFour themes, comprising 11 subthemes were identified. Barriers that affected women’s willingness and capacity to disclose suicidality included: stigma, social expectations of motherhood, not recognising symptoms, not being asked about PMH and/or rushed appointments, lack of care continuity, and HCPs interpersonal skills. Important facilitators were the provision of PMH information and peer support. Women also suggested providing more choice in how PMH and suicide-related questions are administered (e.g., via a form and in-person) and for HCPs to frame these discussions sensitively. ConclusionsSignificant barriers impact perinatal women’s disclosure of suicidality. Appropriate approaches for identifying suicidality in maternity contexts need to be developed that take account of these barriers and support women to feel safe, comfortable, and able to answer suicide-related questions honestly.

Perspectives of providing magnesium sulfate to patients with preeclampsia and eclampsia: A qualitative study amongst nurse-midwives in Dar es Salaam, Tanzania.

Preeclampsia and eclampsia are among the leading direct causes of maternal death and morbidity worldwide. Up to 34% of maternal deaths in Tanzania are due to preeclampsia/ eclampsia. Magnesium sulfate is recommended for preventing and treating convulsions in women with Preeclampsia or eclampsia. However, evidence suggests limited knowledge of its dosage and proper toxicity assessment after administration among health care providers. This study explored nurse-midwives' perspectives on providing MgSO4 to patients with preeclampsia or eclampsia in Tanzania. A descriptive exploratory qualitative study using in-depth interviews was conducted to understand nurse-midwives' perspectives on providing magnesium sulfate to patients with PE/E. Nineteen nurse-midwives were interviewed from three hospitals in the Dar es Salaam region. We used a semi-structured interview guide in Kiswahili language to collect data. All interviews were digitally recorded and transcribed verbatim. We analyzed data using inductive content analysis. This study revealed that nurse-midwives provide magnesium sulfate to save the lives of women and their unborn children. Nurse-midwives reasoned that confidence in their skill enhances provision of magnesium sulfate. However, they were concerned about its effect on the progress of labour. Ineffective use of magnesium sulfate emerged from inadequate training, an unsupportive work environment, and underutilization of the existing guidelines. Nurse-midwives have clear drive to provide magnesium sulfate to women with preeclampsia or eclampsia. However, inadequate training, underutilization of guidelines and unsupportive work environment lead to ineffective use of magnesium sulfate. Targeted practical training should be emphasized for nurse-midwives mastery of clinical competencies.

Legal issues in the implementation of Maternal Death Surveillance and Response: a scoping review.

The Maternal Death Surveillance and Response (MDSR) system is designed to continuously identify and review all maternal deaths. It aims to help countries understand the scale and distribution of maternal deaths, identify their causes, and inform corrective measures to address the challenge. Despite the growing adoption of the MDSR by numerous low- or middle-income countries, its implementation faces various challenges, including legal ones. This scoping review was conducted to map legal issues and challenges that arise during the implementation of the MDSR. It adapted the Bain and Kongnyuy framework, categorizing legal issues into data, people, use of findings, and legal regulation. Literature was retrieved from seven databases, complemented by additional online searches. We included studies published in English between 2010 and November 2022 that report on legal issues arising during the implementation of MDSR. Out of 1174 studies screened, 31 were selected for review. The review highlighted the limited attention given to the legal dimension of the MDSR by the research community. It also documented the lack of adequate legal framework essential for the system's effective implementation. Inadequate safeguards for informational privacy and the lack of confidentiality reinforce a prevalent sense of being blamed, mainly among health workers. Consequently, widespread under-reporting and intentional misattribution of causes of maternal death, defensive referrals, and disengagement from the MDSR process were reported. We recommend that implementing countries regulate the gathering and use of MDSR data through appropriate laws and legally ensure that the MDSR data are only used for the intended purpose. Appropriate complaint-handling mechanisms are needed in health systems to prevent the misuse of the MDSR. Future studies on MDSR implementation would benefit from involving legal experts, considering the multifaceted legal dimensions of the MDSR.

Cesarean Delivery in Case of Retroplacental Hematoma in a Reference Health Center in Bamako, Mali

Introduction: Retroplacental hematoma is a significant cause of maternal death in developing countries. The objective of this study was to study the retroplacental hematoma at the reference health center (CSRef) of commune V of the district of Bamako. Patients and Method: This was a cross-sectional study conducted at the gynaecological and obstetrics department of the CSRéf of commune V in the district of Bamako. It involved 117 cases of retroplacental hematoma. Data entry and analysis were carried out on the Epi info software version 6.2. Results: Our study found that the frequency of retroplacental hematoma was 1.44%. The preferred age was 20 to 34 years (76.3%). Large multiparous women were the most affected (38.1%) and 6.2% of patients had a history of HRP. Caesarean section was the most commonly used route of delivery (82.9%) and the fetal prognosis was very poor (64% of fresh stillbirths). Postoperative complications were dominated by anaemia (81.4%). Conclusion: Retroplacental hematoma is a worrying pathology because of its maternal and perinatal morbidity and mortality.

Nonpneumatic anti-shock garment utilization for obstetric hemorrhage management and its predictors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

IntroductionNon-pneumatic Anti-Shock Garment (NASG) is a lightweight, reusable first aid compression device that squeezes blood from the lower extremities and centralizes blood circulation to vital organs of the body. Postpartum hemorrhage followed by severe preeclampsia/eclampsia is the leading primary cause of maternal death (A reduction in extreme maternal adverse outcomes and faster recovery from shock are more likely to occur with earlier NASG intervention. The median blood loss reduced by half when the NASG was used for obstetric hemorrhage management, which was associated with significantly reduced maternal mortality among the most severe cases.ObjectiveTo estimate the pooled prevalence of NASG utilization and its predictors in Ethiopia.MethodsAppropriate and comprehensive searches of PubMed, MEDLINE, EMBASE, Google Scholar, HINARI, and Scopus were performed. The electronic literature search was last performed on November 18/2023. All observational study designs were eligible for this SRMA. All cross sectional studies reporting the prevalence/proportion of NASG utilization for obstetric hemorrhage management among obstetric care providers and associated factors were included in this SRMA. Primary studies lacking the outcome of interest were excluded from the SRMA. The extracted Microsoft Excel spreadsheet data were imported into STATA software version 17 (STATA Corporation, Texas, USA) for analysis. A random-effects model was used to estimate the pooled prevalence of NASG utilization among obstetric care providers in Ethiopia. The Cochrane Q-test and I2 statistics were computed to assess the heterogeneity among the studies included in the SRMA.ResultA total of 1623 articles were found by using our search strategies and seven studies comprising 2335 participants were ultimately included in the SRMA. The pooled prevalence of NASG utilization for obstetric hemorrhage in Ethiopia was 43.34% (95% CI: 35.25, 51.42%). The findings of this subgroup analysis by sample size showed that the pooled prevalence of NASG utilization for obstetric hemorrhage was greater in studies with sample sizes of less than the mean sample size (48.6%; 95% CI: 32.34, 64.86%). Receiving training (AOR = 3.88, 95% CI: 2.08–5.37), having good knowledge (AOR = 1.99, 95% CI: 1.28–3.16), positive attitude (AOR = 2.16, 95% CI: 1.62–2.75) and having available NASGs in the facility (AOR = 4.89, 95%CI: 2.88–8.32) were significantly associated with the use of NASGs for obstetric hemorrhage management.ConclusionThe level of NASG utilization for obstetric hemorrhage in Ethiopia is low. Receiving training, good knowledge, positive attitudes and availability of NASG were significantly associated with the utilization of NASG. Therefore, policy makers and other stakeholders should emphasize enhancing the knowledge and attitudes of obstetric care providers through continuous support and training. At the same time, they should work strictly in providing devices for all the health facilities.

The burden of hypertension as Brazil's leading cause of maternal deaths: The lost decade

The burden of hypertension as Brazil's leading cause of maternal deaths: The lost decade

Trends and causes of maternal mortality in Indonesia: a systematic review

BackgroundThe maternal mortality ratio (MMR) in Indonesia is among the highest in Southeast Asia. We aim to describe trends in the MMR and causes of maternal deaths in Indonesia over the past decades, regionally and nationally.MethodsWe performed a systematic review and conducted a search using PubMed, Embase, Global Health, CINAHL, Cochrane, Portal Garuda, and Google Scholar from the inception of the database to April 2023. We included all studies on the incidence and/or the causes of maternal deaths in Indonesia. The MMR was defined as the number of maternal deaths per 100,000 live births. Maternal death causes were assessed and reclassified according to the WHO International Classification of Disease Maternal Mortality (ICD-MM).ResultsWe included 63 studies that reported the MMR (54 studies) and/or the causes of maternal deaths (44 studies) in Indonesia from 1970 to 2022, with a total of 254,796 maternal deaths. The national MMR declined from 450 to 249 (45%) between 1990 and 2020. Great differences in MMR exist across the country, with the lowest in Java-Bali and the highest (more than twice the national MMR) in Sulawesi and Eastern Indonesia. Between 1990 and 2022, the proportion of deaths due to hemorrhage and sepsis decreased, respectively from 48 to 18% and 15–5%, while the share of deaths due to hypertensive disorders and non-obstetric causes increased, respectively from 8 to 19% and 10–49%.ConclusionDespite the steady decline of maternal deaths in Indonesia, it remains one of the highest in Southeast Asia, with enormous disparities within the country. Hypertensive disorders and non-communicable diseases make up a growing share of maternal deaths, making maternal death reduction strategies increasingly challenging. National Maternal Death Surveillance and Response needs to be prioritized to eliminate preventable maternal deaths in Indonesia.Registration of systematic reviewsPROSPERO, CRD42022320213.